HPI: E.D. is a 52 year old woman with a 15 year history of seizures.

Seizure type 1: CPS (poor history)

• feels weak, loses energy, words slur, headache

Seizure type 2: GTC

• shaking in all 4 extremities x 1-2 minutes
• urinary incontinence
• postictal confusion
• sleeps a day or so
• occur up to once every 2-3 months

PMH/PSH:

• s/p tubal ligation
• s/p CCK
• s/p sinus surgery
• NEE
• asthma
• seizures
• HTN
• migraine with aura

Current AEDs: gabapentin, topamax

Prior AEDs: Dilantin, Depakote, Trileptal, Phenobarbital

other meds: theophylline, hyzaar, combivent, flovent, claritin-D, singulair

Soc:

• married, housewife, 12 children, two adopted

FH: two cousins + 1 niece with seizures

video EEG 9/2001 at BJH

Interictal:

• normal

Ictal: one nonepileptic event

• 13 seconds of rythmic leg shaking
• unresponsive for a couple of minutes

video EEG 1/13/2003 to 1/20/2003 at BJH

Interictal:

• rare left temporal slowing
• 8 Hz. alpha rhythm (attributed to phenobarbital)

Ictal:

• no seizures

MRI, seizure protocol, BJH 1/2003

• normal

video EEG 1/5/2009 to 1/7/2009 at BJH

Interictal:

• left temporal slowing
• left frontal or bifrontal SW discharges

Ictal:

• five seizures, all left hemispheric onset

Seizure #1:

Seizure #3:

Seizure #5:

MRI, seizure protocol, and MR Spect, BJH 2/9/2009

• left MTS
• mildly elevated choline peaks bilateral temporal lobes

PET, BJH 2/9/2009

• bilateral temporal hypometabolism

NPT 5/6/2009:

• low average intellectual functioning
• nonlateralizing

Surgery conference 5/14/2009:

Assessment:

• The ictal, interictal, and MRI findings are concordant for left mesial temporal lobe epilepsy

Suggested plan:

• left selective AHC
• caveat: family reports reduced seizure frequency (none since ... ?)